The Risk Management (or Adjustment) process primarily takes place in Medicare, where the payor is the administrator of plans paid by the U.S. Government through CMS. Both as an ongoing activity as part of Claims Adjudication or a one-off audit exercise, this involves evaluating medical records to identify conditions that can be coded to map with the CMS database (ICD10) and receive payouts accordingly.
Instabase for Risk Management
Instabase automates document understanding for the medical coding process, streamlining risk management (or adjustment) of Medicare claims.
Processing Medical Coding for Risk Management
Why Instabase?
The Instabase Automation Platform for Unstructured Data helps payors automate the medical coding process, creating greater accuracy and saving costs.
Unlock unstructured data that others can’t
Understand your most complex documents with the latest in AI from Instabase and the broader market
Achieve unrivaled automation & accuracy
Minimize errors and boost automation with an extensive suite of validations and business logic
Build solutions 10x faster
Launch end-to-end solutions in days with low code building blocks for every step in your workflow
How it works
Instabase combines the most powerful technologies for every step of the process, so you can automatically understand any document in the submissions process.
Digitize
Connect to any file system or email inbox and transform documents and images into a consistent, machine-readable format.
- Pre-process and enhance image quality
- Transcribe handwritten and printed text
- Support up to 160+ languages
- Recognize logos, signature, checkboxes, and other elements
Classify
Categorize documents by type and route to appropriate channels and teams. Large packets with multiple documents are automatically separated into logical records.
- Packet splitting
- Classification
Extract
Automatically extract the information you need from any type of document without the hassle of rules or templates. Understand the full spectrum of documents with state-of-the-art deep learning.
Document Types:
- Structured (fixed layout)
- Semi-structured (variable layout)
- Unstructured (free form)
Visual Features:
- Tables
- Signatures
- Checkboxes
Refine
Enhance model results, perform calculations, and prepare data for downstream decision-making with tools for data manipulation and transformation.
- Clean erroneous and duplicative information
- Enrich with internal or external data sources
- Transform data into appropriate format and schemas
Validate
Verify data with comprehensive checks to identify errors and automate results with high accuracy. Provide real time feedback to customers when issues arise from user error and incorrect documentation.
- Validate with custom logic, business rules, and confidence thresholds
- Match results against internal databases
- Deliver real-time notifications of document status
Review
Loop in a human to approve or correct any values that require attention or if you ever want an extra pair of eyes.
- Easily compare extracted data with source documents
- Re-validate corrections against business rules
- Assign checkpoints at any stage of the workflow
Integrate
Export results to any downstream application in the required schema.
- CRM
- ERP
- CMS
- Client Portal
- Data Warehouse
- Core Systems
